Diabetic ketoacidosis at the onset of disease during a national awareness campaign: a 2-year observational study in children aged 0-18 years

After a previous survey on the incidence of diabetic ketoacidosis (DKA) at onset of type 1 diabetes in children in 2013-2014 in Italy, we aimed to verify a possible decline in the incidence of DKA at onset during a national prevention campaign

The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020

To compare the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in Italy during the COVID-19 pandemic in 2020 with the frequency of DKA during 2017-2019

What does the patient have to say? Valuing the patient experience to improve the patient journey

Background Patient-reported data—satisfaction, preferences, outcomes and experience—are increasingly studied to provide excellent patient-centred care. In particular, healthcare professionals need to understand whether and how patient experience data can more pertinently inform the design of service delivery from a patient-centred perspective when compared with other indicators. This study aims to explore whether timely patient-reported data could capture relevant issues to improve the hospital patient journey. Methods Between January and February 2019, a longitudinal survey was conducted in the orthopaedics department of a 250-bed Italian university hospital with patients admitted for surgery; the aim was to analyse the patient journey from the first outpatient visit to discharge. The same patients completed a paper-and-pencil questionnaire, which was created to collect timely preference, experience and main outcomes data, and the hospital patient satisfaction questionnaire. The first was completed at the time of admission to the hospital and at the end of hospitalisation, and the second questionnaire was completed at the end of hospitalisation. Results A total of 254 patients completed the three questionnaires. The results show the specific value of patient-reported data. Greater or less negative satisfaction may not reveal pathology-related needs, but patient experience data can detect important areas of improvement along the hospital journey. As clinical conditions and the context of care change rapidly within a single hospital stay for surgery, collecting data at two different moments of the patient journey enables researchers to capture areas of potential improvement in the patient journey that are linked to the context, clinical conditions and emotions experienced by the patient. Conclusion By contributing to the literature on how patient-reported data could be collected and used in hospital quality improvement, this study opens the debate about the use of real-time focused data. Further studies should explore how to use patient-reported data effectively (including what the patient reports are working well) and how to improve hospital processes by profiling patients’ needs and defining the appropriate methodologies to capture the experiences of vulnerable patients. These topics may offer new frontiers of research to achieve a patient-centred healthcare system

The experiences of protective isolation in patients undergoing bone marrow or haematopoietic stem cell transplantation: systematic review and metasynthesis

Protective isolation is aimed at preventing infection in neutropenic patients, but it is implemented inconsistently across centres and is supported by recommendations with poor evidence. This review and metasynthesis explored the experiences and the psychological implications of protective isolation in patients with haematological malignancies undergoing bone marrow (BMT) or haematopoietic stem cell transplantation (HSCT). A systematic search of multiple databases for qualitative studies exploring BMT or HSCT patients' experiences of protective isolation was completed. The metasynthesis followed the meta-aggregative method from the joanna briggs Institute, with four procedural steps: (1) comprehensive search, (2) quality appraisal, (3) extraction of relevant findings and (4) synthesis of the identified findings. Twenty-six findings were extracted from 11 articles included in the review. the synthesising process yielded seven categories, aggregated into three synthesised findings: (1) isolation is a source of suffering, (2) isolation can lead to relating with oneself and (3) the person does not close the door to the outside world. this metasynthesis sheds light on patients' suffering from being isolated, and the possibility of overcoming this suffering thanks to relationships that patients have with themselves and with the external world. healthcare providers should reconsider this practise in order to avoid unnecessary patient suffering

La promozione del self-care in ambito nutrizionale nella persona anziana: protocollo di ricerca con metodo misto

Scopo. Descrivere un progetto di ricerca disegnato per promuovere il self-care in ambito nutrizionale nelle persone anziane. La ricerca si propone di: a) valutare l'efficacia di un intervento educativo per la modifica di conoscenze, comportamenti e atteggiamenti in ambito nutrizionale; b) descrivere l'abilití  e i comportamenti di self-care in rapporto alla nutrizione; c) identificare i fattori favorenti o le barriere ai cambiamenti nelle conoscenze, comportamenti e atteggiamenti nutrizionali.Metodo. Il disegno di ricerca sarí  di tipo misto sequenziale esplicativo. Lo studio prevede l'arruolamento di 50 persone di etí  uguale o superiore a 65 anni. Nella prima fase quantitativa sarí  usato un disegno pre-test e post-test per la realizzazione di un intervento educativo mirato alla modificazione di conoscenze, comportamenti e atteggiamenti in ambito nutrizionale. Sulla base dei risultati dell'intervento educativo sarí  condotta la fase qualitativa dello studio con la realizzazione di focus group in sottogruppi di anziani. In una terza fase i risultati quantitativi e qualitativi saranno integrati. I dati quantitativi saranno analizzati attraverso metodi statistici descrittivi e inferenziali e i dati qualitativi attraverso l'analisi del contenuto. Risultati. Lo studio fornirí  nuove conoscenze su come le persone anziane si prendono cura di sé, e sui fattori che promuovono il self-care in ambito nutrizionale. Conclusione. La promozione del self-care è un obiettivo importante per il personale infermieristico nell'ambito dell'assistenza alle persone anziane. I programmi educativi rivolti al mantenimento di una corretta alimentazione nell'anziano possono contribuire a ridurre la malnutrizione e le malattie correlate e devono basarsi su conoscenze derivate dalla ricerca che possono rendere gli interventi più efficaci ed individualizzati. Parole Chiave: promozione della salute, cambiamenti di comportamento, nutrizione, self-care, nursing, infermieri, anziani, metodo mistoNutritional self-care promotion in community-dwelling older people: a protocol of mixed method researchAim. To describe a research protocol designed to promote nutritional self-care in older people. The aims of the research are: a) to evaluate the effectiveness of a nutritional education intervention in changing knowledge, attitudes, and behaviors; b) to describe the nutritional self-care ability and activities; c) to identify the promoting factors and barriers that influence the changes in nutritional knowledge, behaviors and attitudes in home-dwelling older people.Method. Sequential explanatory mixed method design. The study will enroll 50 people aged 65 years and over. In the first quantitative phase, a pre-test and post-test design will be used to deliver a nutritional intervention aimed to change knowledge, behaviors and attitudes toward nutrition. Using the quantitative study results, the qualitative study phase will be conducted by interviews in sub-groups of older people. In a third phase, the quantitative and qualitative study results will be integrated. Quantitative data will be analyzed using descriptive and inferential statistics and qualitative data will be analyzed through content analysis.Results. The study will provide new knowledge on nutritional self-care in home-dwelling older adults and the factors promoting nutritional self-care.Conclusion. Nutritional self-care promotion is of pivotal importance for the nursing care provided to home-dwelling older people. Educational programs aimed at the maintenance of proper nutrition in the older adults may reduce malnutrition and the related diseases. Nutrition educational programs should be based on knowledge derived from research to tailor individualized nutritional interventions and to realize effective educational programs.Key words: health promotion, behavior change, nutrition, self-care, nursing, nurses, older people, mixed metho

Can Smart Home Technologies Help Older Adults Manage Their Chronic Condition? A Systematic Literature Review

The management of chronic diseases requires personalized healthcare that allows older adults to manage their diseases at home. This systematic review aimed to describe the smart home technologies used in the management of chronic diseases in older people. A systematic literature review was conducted on four databases and was reported following the PRISMA statement. Nineteen articles were included. The intervention technologies were classified into three groups: smart home, characterized by environmental sensors detecting motion, contact, light, temperature, and humidity; external memory aids, characterized by a partnership between mobile apps and smart home-based activity learning; and hybrid technology, with the integration of multiple technologies, such as devices installed at patients’ homes and telemedicine. The health outcomes evaluated are vital signs, medication management, ADL-IADL, mobility, falls, and quality of life. Smart homes show great potential in the management of chronic diseases by favouring the control of exacerbations and increasing patients’ safety by providing support in disease management, including support for cognitively impaired older people. The use of smart homes in the community could bring numerous benefits in terms of continuity of care, allowing the constant monitoring of older people by local and hospital health services

Use of Motivational Interviewing in Older Patients with Multiple Chronic Conditions and Their Informal Caregivers: A Scoping Review

The use of motivational interviewing is relatively new in multiple chronic conditions (MCCs). A scoping review was conducted according to JBI methodology to identify, map and synthesize existing evidence on the use of motivational interviewing to support self-care behavior changes in older patients with MCCs and to support their informal caregivers in promoting patient self-care changes. Seven databases were searched, from database inception to July 2022, for studies that used motivational interviewing in interventions for older patients with MCCs and their informal caregivers. We identified 12 studies, reported in 15 articles, using qualitative, quantitative, or mixed-method designs, conducted between 2012 and 2022, describing the use of motivational interviewing for patients with MCCs. We could not locate any study regarding its application for informal caregivers. The scoping review showed that the use of motivational interviewing is still limited in MCCs. It was used mainly to improve patient medication adherence. The studies provided scant information about how the method was applied. Future studies should provide more information about the application of motivational interviewing and should address self-care behavior changes relevant to patients and healthcare providers. Informal caregivers should also be targeted in motivational interviewing interventions, as they are essential for the care of older patients with MCCs

L'evoluzione del concetto di cura di sé nell'assistenza sanitaria: una revisione narrativa della letteratura

Scopo: Descrivere ed analizzare le definizioni del concetto di self-care in ambito sanitario nella loro evoluzione temporale ed individuare i protagonisti della cura di sé. Metodo: E' stata condotta una revisione narrativa della letteratura consultando le banche dati CINAHL, PubMed, ed ILISI, senza limiti temporali. Inoltre è stata eseguita un'analisi secondaria della bibliografia degli articoli selezionati per individuare ulteriori fonti. Le definizioni di self-care reperite sono state raggruppate per decadi sulla base della loro data di pubblicazione ed esaminate nella loro evoluzione nel tempo. Risultati: Anche se le prime definizioni di self-care compaiono in letteratura negli anni settanta, è solo a partire dagli anni ottanta che il self-care viene considerato a tutti gli effetti una risorsa fondamentale per i sistemi sanitari. Negli anni novanta attivití  di cura considerate in passato di pertinenza esclusiva delle professioni sanitarie vengono ricomprese in questo concetto. Negli anni duemila viene formalizzato il ruolo dei professionisti della salute nel processo di self-care, e le attivití  di self-care si estendono alla sfera psicologica, sociale e spirituale. I comportamenti di self-care possono essere attuati direttamente dalla persona su di sé, delegati ad altri, oppure svolti su altri. Conclusioni: La revisione ha mostrato l'ampia letteratura pubblicata sul self-care in vari ambiti disciplinari e culturali, che ha portato al proliferare di definizioni ed interpretazioni. L'Italia risulta aver partecipato in maniera marginale al dibattito internazionale. Sarebbe, pertanto, utile che anche gli infermieri italiani avviassero progetti di ricerca per comprendere il fenomeno del self-care nell'ambito culturale e sanitario italiano.Parole chiave: cura di sé, salute, malattie croniche, assistenza infermieristicaThe evolution of the concept of self-care in the healthcare system: a narrative literature reviewABSTRACTPurpose: To identify and analyze the definitions of self-care in the healthcare system in the evolution over time as well as to identify the key actors of self-care. Method: We conducted a narrative review of the literature on the definition of self-care in the CINAHL, PubMed and ILISI databases. The searches ranged from the first year included in each database until May 2013. In addition, a secondary analysis was performed on the references of articles selected to identify additional data sources. The self-care definitions were grouped according to decades and examined in their evolution. Results: The first self-care definitions date back to the seventies, but only in the eighties self-care has been seen as a key resource for healthcare systems. In the nineties, care activities previously considered the exclusive domain of the health professions were included in this concept; and finally over the 2000s the role of health professionals in self-care is highlighted, extending the self-care activities to the psychological, social and spiritual dimensions. Self-care activities can be carried out directly by the person upon himself, delegated to others, or performed on others. Conclusions: The review has showed the large body of literature published in different disciplinary and cultural fields, which has led to the proliferation of definitions and interpretations of self-care. Italy has taken part in a marginal way to the international debate. It would be useful that also Italian nurses did research to describe and understand.Key words: self-care, health, chronic diseases, nursing Key words: self-care, health, chronic diseases, nursin